APPLICATION FORM FOR POSTS OF REGISTRAR

Transcription

1 APPLICATION FORM FOR POSTS OF REGISTRAR Note: Prospective candidates are advised to study the Instructions carefully and then fill up the application in all respects. No column should be left blank. Incomplete application will be rejected. Attach additional sheets, if required. However, information given must be precise to the point. Application No.: Date of Receipt of Application Form: (For Office use Only) Registration No: (For Office use Only) Details of application fees (please attach original DD with application) DD Number & Date Amount Name of the Bank DD issuing Branch's Name 1. Name of the Post Applied for: Registrar Paste your recent colour passport size signed photo 2. Personal Details: (a) Name (in capital letters) First Name Middle Name Surname (b) Date of Birth Day Month Year Age as on date of Advertisement Years Months c) Father's Name d) Mother's Name e) Nationality f) Gender Male / Female g) Religion h) Community/Category GEN / SC / ST / SEBC /Other categories: lf other Categories give details i) Marital Status Married/ Unmarried j) lf physically disabled indicate the relevant particulars i) Blindness or Low Vision ii) Hearing impairment iii) Locomotors Disability or Cerebral Palsy(includes all cases of Orthopedically Handicapped) k) Present Postal Address with Pin Code lf applicable write "Yes" Percentage of Disability

2 Mobile Phone Number: Telephone No with STD Code: AADHAR No. 3. Educational Qualifications: (attach additional pages if required) Name of the Course Name of the Board/University Month & Year Passed % of Marks Aggregate Marks Subjects Studied 10 th Class/ Equivalent 12 th Class/ Equivalent Bachelor's Degree Master's Degree M.Phil. Ph.D. Any other 4. Experience: (use separate sheet is space in-sufficient) Designation Scale of Pay Name & Address of the Employer permanent/ Temporary /Contract/ Others (specify) Period Of Experience From To Nature of work

3 5. Total Period of Experience (Please ensure that the period of Teaching & Research experiences claimed do not overlap) Teaching Research No. of Years No. of Months 6. Publications, if any, in last five years (Mention here only numbers. The details of copies of reprint be enclosed) Publications Published (No.) ISBN/ISSN No. Accepted/ In Print /No ) Books Research Paper Books (edited)/ Chapter in Book Articles Conference Proceedings 7.Seminars/Conferences etc. Seminars/Conferences/workshops/Symposiums/Training/Programmes etc. Organised Seminars/Conferences/workshops/Symposiums/Training/Programmes etc. Participated as per Paper Contributor/Presenter Seminars/Conferences/workshops/Symposiums/Training/Programmes etc. Attended Only 8. Membership in Professional Body In India (No) Communicated (other than published/ Accepted) In Abroad (No) Name of the Organization Annual Member ship Life Membership Membership No. 9. Language Known: (please write yes or no whichever is applicable) Name of Language Read Write Speak Gujarati Hindi English Other 10. References (three) 1. Name: _ Postal Address: _ id: Mobile No.: 2. Name: _ Postal Address: _ id: Mobile No.: 3. Name: _

4 Postal Address: _ id: Mobile No.: 11 Write a note on a separate sheet in about 200 words stating the nature of your academic/ administrative contribution to the university /department/programme/faculty where you served earlier. (Attach separate sheet) 12 Your vision and future plan for the overall development in about 200 words for the department/programme/university in which you have applied. (Attach separate sheet) 13 Time required to join, If offer of appointment will be issued? 14 Have you ever been arrested/prosecuted/kept in detention/convicted by a court of Law or whether any case is pending against you in a Court of Law? Yes No If the answer to the above question is Yes give details 15 Have you ever been debarred from any examination/rusticated by any University or any other educational institution or whether any case is pending against you in any University or any other educational institution? Yes No. If the answer to the above question is Yes give details 16 Has any disciplinary action been taken against you by any University/ Institute where you have served? Yes No If Yes give details. Declaration I...Son/Daughter of...hereby declare that all the statements and entries made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the selection committee and during my entire career, my candidate/appointment may be cancelled by the University Date: Signature of the Applicant Place: Name (in block letters): (Application not signed by the candidate liable to be rejected)

5 Endorsement by the Employer: (The endorsement below is to be signed & Forwarded by the Head of the Institution /Employer of the organization/ institution in the case of the in-service candidate) Forwarded to The Registrar. GUJARAT UNIVERSITY OF TRANSPLANTATION SCIENCES IKDRC-ITS Premises, Civil Hospital Campus, Asarwa, Ahmedabad , Gujarat, India The applicant Dr /Mr /Mrs./Ms.... who has submitted this application for the post of... in GUJARAT UNIVERSITY OF TRANSPLANTATION SCIENCES has been working in this organization namely... in the post of... in a the temporary/contract/permanent capacity with effect from... in the scale of pay of Rs.... He/ She is drawing a basic pay of Rs.... Further, it is certified that the applicant has requisite qualifications experiences as per the post advertised. No disciplinary/vigilance case has ever been held or contemplated or is pending against the said applicant. There is no objection for his/her application being Considered by the GUJARAT UNIVERSITY OF TRANSPLANTATION SCIENCES Signature of Forwarding Officer Name:... Designation:... Place:... Date:... Seal

6 List of Documents Attached as per instruction on Sr.no 10 Sr. No Documents Page no